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J Thorac Cardiovasc Surg 2004;128:617-618
© 2004 The American Association for Thoracic Surgery

Brief communication

Twisting of pedicled left internal thoracic artery graft three hundred sixty degrees clockwise: Does it change the outcome?

Apurba Kumar Sarma, MCha,*, Sai Kiran Krishnamurthya, Venkata Sathya Siva, MSa, Jayakumar Karunakaran, MCha, Neelakandhan Kurur Sankaran, MCha

a Department of Cardio-vascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India

Received for publication January 16, 2004; accepted for publication January 27, 2004.

* Address for reprints: Apurba K. Sarma, MCh, Flat No. B2, New Faculty Building, SCT Housing Colony, Kumarapuram, Poonthi Road, Thiruvananthapuram, 695011 Kerala, India
aks@sctimst.ac.in

The first 20% of the full text of this article appears below.


Sai Kiran, Sarma, Neelakandhan, Jayakumar (left to right)


Twisting of aorta-coronary venous conduits has been reported previously with fatal outcome and is an extremely uncommon occurrence.1 However, twisting of the pedicled left internal thoracic artery (LITA) graft was not found to be reported in a search of the English-language literature (MEDLINE and PUBMED), and its outcome is unknown. We report a case of an inadvertent clockwise 360° twisting of a LITA graft sequentially anastomosed to the diagonal and left anterior descending coronary arteries (LAD) with an angiographically documented patency with good distal runoff.

Clinical summary

A 54-year-old man had a history of class III unstable angina. Echocardiographic evaluation was unremarkable. The treadmill test result was positive for inducible ischemia. Coronary angiography showed a normal left main coronary artery and total occlusion of the proximal LAD. The diagonal artery was arising from the diseased segment of the LAD. The left circumflex artery was nondominant and normal. The right coronary artery was totally occluded . . . [Full Text of this Article]






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